title: Clinical efficacy and prognostic indicators for lower limb pedalling exercise early after stroke: study protocol for a pilot randomised controlled trial.
abstract: BACKGROUND
  It is known that repetitive, skilled, functional movement is beneficial in driving functional reorganisation of the brain early after stroke. This study will investigate a) whether pedalling an upright, static exercise cycle, to provide such beneficial activity, will enhance recovery and b) which stroke survivors might be able to participate in pedalling.
  
  
  METHODS
  Participants (n = 24) will be up to 30 days since stroke onset, with unilateral weakness and unable to walk without assistance. This study will use a modified exercise bicycle fitted with a UniCam crank. All participants will give informed consent, then undergo baseline measurements, and then attempt to pedal. Those able to pedal will be entered into a single-centre, observer-blinded randomised controlled trial (RCT). All participants will receive routine rehabilitation. The experimental group will, in addition, pedal daily for up to ten minutes, for up to ten working days.Prognostic indicators, measured at baseline, will be: site of stroke lesion, trunk control, ability to ambulate, and severity of lower limb paresis.The primary outcome for the RCT is ability to voluntarily contract paretic lower limb muscle, measured by the Motricity Index. Secondary outcomes include ability to ambulate and timing of onset and offset of activity in antagonist muscle groups during pedalling, measured by EMG.
  
  
  CONCLUSIONS
  This protocol is for a trial of a novel therapy intervention. Findings will establish whether there is sufficient evidence of benefit to justify proceeding with further research into clinical efficacy of upright pedalling exercise early after stroke. Information on potential prognostic indicators will suggest which stroke survivors could benefit from the intervention.
  
  
  BACKGROUND
  ISRCTN: ISRCTN45392701.
authors.affiliation: Institiute of Health and Social Sciences, Faculty of Health, University of East Anglia, Norwich, UK. n.hancock@uea.ac.uk
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Hancock
authors.forename: Lee
authors.initials: L
authors.lastname: Shepstone
authors.forename: Philip
authors.initials: P
authors.lastname: Rowe
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.forename: Valerie
authors.initials: V
authors.lastname: Pomeroy
mesh_terms: D001642:Bicycling; D004185:Disability Evaluation; D004576:Electromyography; D004867:Equipment Design; D005081:Exercise Therapy / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D035002:Lower Extremity; D009043:Motor Activity; D009119:Muscle Contraction; D053580:Muscle Strength; D018908:Muscle Weakness / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010865:Pilot Projects; D020127:Recovery of Function; D012107:Research Design; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom